MEDICARE: SETH ANDREW LEALI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301010952	MI

General Provider Information

NPI Number	:	1942823695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SETH ANDREW LEALI

Provider Business Mailing Address
First Line	:	2156 LANSING ST SE
Second Line	:
City	:	EAST GRAND RAPIDS
State	:	MI
Zip	:	49506-2014
Country	:	US
Telephone Number	:	616-666-0721
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 MARYLAND AVE NE STE B
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-6052
Country	:	US
Telephone Number	:	616-666-0721
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2020
Last Update Date	:	05/28/2020

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